NPI | 1225021140 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 20050035766) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0428745) |
Enumeration Date | 2005-08-25 |
Last Update Date | 2025-03-20 |